Features Distinguishing Localized (Bullous Impetigo) from Generalized Staphylococcal Scalded Skin Syndrome (SSSS)

Description

Bullous impetigo is a form of infection with Staphylococcus aureus with bullae limited to one area, hence its name localized staphylococcal scalded skin syndrome. It differs in a number of features from the generalized form, in which the exfoliatoxin is absorbed into the blood.

Similarities between the 2 conditions:

(1) both involve phage 2 positive Staphylococcus aureus with exfoliatoxin

(2) both show an intraepidermal subgranular cleavage plane

Parameters distinguishing the 2 conditions:

(1) distribution of bullae

(2) Gram stain and culture from intact bulla

(3) cutaneous erythema and tenderness

(4) Nikolsky sign

(5) inflammation in the dermis

Parameter	Localized	Generalized
distribution	limited to a body site	all of the body
Gram stain and culture	positive	negative
erythema and tenderness	absent	present
Nikolsky sign	negative	positive
dermal inflammation	present	absent

Some patients with localized SSSS may progress to the generalized form.

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Description

Specialty

ICD-10